An Unintended Consequence

The health coverage plan providers, companies like Humana, Aetna, Anthem, et al., are gaming the Medicare system to keep their Medicare bonuses coming in.  Surprise.

It seems that when Obamacare was passed, it included a system of paying bonuses from Medicare to those plan providers that got sufficiently high ratings on the quality of their plans.

But wait….

Medicare ranks privately managed plans…on a five-star quality scale and provides financial bonuses to providers of top-ranked plans. [A plan-holder’s] plan was set to be downgraded, which would have cost Humana its bonus. So the company merged plans covering [the plan-holder] and more than a million others into different contracts with higher scores. That preserved the bonuses.

A New Insurance Plan

Idaho has one.  Blue Cross of Idaho says it’s going to take advantage of newly issued State regulations to start marketing a plan that won’t meet Obamacare requirements, and they’re going to sell the plan alongside its existing Obamacare-compliant plans.

The Idaho Department of Insurance last month became the first state regulator to say it would let insurers begin offering “state-based plans” for consumers that involved practices generally banned for individual insurance under the ACA, including tying premium rates to enrollees’ pre-existing health conditions.

In particular,

A New Welfare Trap

This one is in the offing at the State level, and comes as a result of the punitive tax for not buying health coverage was repealed last December.

At least nine states are considering their own versions of a requirement that residents must have health insurance….

And

Maryland lawmakers are pursuing a plan to replace the ACA mandate, which requires most people to pay a penalty if they don’t have coverage. California, Connecticut, Hawaii, Minnesota, New Jersey, Rhode Island, Vermont, and Washington, as well as the District of Columbia, are publicly considering similar ideas.

Working for a Living

Indiana has joined Kentucky in getting approval to add a work requirement to its Medicaid program (separately: Federal approval should not be a requirement; the program should be a State-run and -funded program only).

Of course, there are objections.

Democrats and consumer groups are decrying the GOP push, saying it is antithetical to Medicaid’s goal of expanding health care.

It’s a Start

The Centers for Medicare & Medicaid Services has been instructed by President Donald Trump to adjust its rules to allow the States to adjust their own rules to require work for Medicaid payments.

This is a very good start.  There are two remaining steps, though.  The funds transferred to the States in support of Medicaid need to be converted to block grants with no strings attached.  Each State knows its own medical support needs far better than does the Federal government.

The Veteran’s Choice Program

This is a program that would give veterans the option of going to a private sector doctor in lieu of playing the delay wait game at a Veterans Administration facility, after the veteran has jumped through the requisite VA hoops.  After a political tussle in Congress over increasing/renewing its funding, some additional money was provided.  That additional funding was necessitated because

its popularity depleted the allocated funds more quickly than anticipated. Patient visits through the program increased more than 30% in the first quarter of fiscal year 2017, according to the VA.

Death Panels?

The Affordable Care Act required Medicare to penalize hospitals with high numbers of heart failure patients who returned for treatment shortly after discharge. New research shows that penalty was associated with fewer readmissions, but also higher rates of death among that patient group.

Because sometimes readmission is necessary for quality care—whether that readmission was driven by later complications, by too-soon original discharge in the Medicare (which is to say Government) pressure to hold down costs first, or by some other factor—but that Government pressure to push the patient out the door also pushes against the patient’s return.  Even when necessary.

Obamacare Subsidies

Recall that under Obamacare, health coverage plan providers are required to subsidize low-income Americans (who, under Obamacare, are required to buy the plans regardless of need for the plans on offer or ability to pay the vig for them) for their costs in buying those health coverage plans.  Recall further that the Obama administration paid those plan providers monies to reimburse them for those government-mandated subsidy payouts.  Recall also that Congress never appropriated any funds for the purpose of making those payments to the plan providers.  Finally, recall that a DC District court ruled those payments to the health plan providers illegal—because Congress had not appropriated any funds for the purpose.  Then the Trump administration ceased those payments to the health plan providers.

Health Plan Providers Are Concerned

These providers, which surprisingly The Wall Street Journal misapprehends as insurers, are bracing for a drop in enrollment in the ongoing health plan provision program “turmoil.”  There’s this key passage in the article at the link:

[M]any firms say they expect to lose consumers who will bear the full brunt of the rate increases—those who aren’t eligible for the health law’s premium subsidies, which help enrollees with annual incomes of less than around $48,000.

Health Plan Coverage and Contraception

The Wall Street Journal has noted that the Trump administration has taken regulatory action to reduce, if not eliminate (the Supreme Court still has to do its job vis-à-vis a Little Sisters of the Poor case, as does Congress legislatively, contra a short handful of Republicans who prefer Obamacare intact over any step toward getting rid of it), the requirement that health plan providers provide contraception to women at no cost to those women coverees and do so regardless of any question of conscience or religious tenet.

Naturally, Progressive-Democrats and the Left generally have their collective panties in a wedgie over that.  However, they carefully ignore certain inconvenient facts.